
<div th:fragment="qyxqModel">
	<div class="easyui-panel" title="居民基本信息">
			<table id="jmxxTable" class="form-table">
				<tr>
					<td class="td-text">
						<label>居民姓名：</label>
					</td>
					<td class="td-content">
						<input type="text" name="XM" id="XM"  autocomplete="off" readonly="readonly" 
						   class="layui-input dataField form-control">
						<input name="JMXXID" class="form-control" style="display: none;">
					</td>
					<td class="td-text">
						<label>性别：</label>
					</td>
					<td class="td-content">
						<!-- <select name="XB" id="XB" class="cacheTable dataField form-control" cacheTable="TB_ZY_XB" quick-config="label:'性别', validateProxy:'notNull'"   >
						</select> -->
						<input type="text" name="XB" id="XB"  autocomplete="off" readonly="readonly" 
						   class="layui-input dataField form-control">
					</td>
					<td class="td-text">
						<label>证件号码：</label>
					</td>
					<td class="td-content">
						<input type="text" name="ZJHM" id="ZJHM" autocomplete="off" readonly="readonly"
							   class="layui-input dataField form-control">
					</td>
					<td class="td-text">
						<label>出生日期：</label>
					</td>
					<td class="td-content">
						<input type="text" name="CSRQ" id="CSRQ" readonly="readonly" autocomplete="off" 
							   class="layui-input dataField form-control">
					</td>
				</tr>
				<tr>
					<td class="td-text">
						<label>就诊卡号：</label>
					</td>
					<td class="td-content">
						<input type="text" name="JZKH" id="JZKH"  autocomplete="off" readonly="readonly" 
						   class="layui-input dataField form-control">
					</td>
					<td class="td-text">
						<label>手机号码：</label>
					</td>
					<td class="td-content">
						<input type="text" name="SJHM" id="SJHM" autocomplete="off"  readonly="readonly" 
						   class="layui-input dataField form-control">
					</td>
					<td class="td-text">
						<label>家庭地址：</label>
					</td>
					<td class="td-content" colspan="3">
						<input type="text" name="JTZZ" id="JTZZ" autocomplete="off"  readonly="readonly" 
						   class="layui-input dataField form-control isTitle">
					</td>
				</tr>
				<tr>
					<td colspan="8">
						18岁以下未成年人、精神疾病患者等对象，应由其监护人代为签约，增加以下内容：
					</td>
				</tr>
				<tr>
					<td class="td-text">
						<label>监护人姓名：</label>
					</td>
					<td class="td-content">
						<input type="text" name="JHRXM" id="JHRXM" autocomplete="off" readonly="readonly" 
						   class="layui-input dataField form-control">
					</td>
					<td class="td-text">
						<label>与甲方关系：</label>
					</td>
					<td class="td-content">
						<input type="text" name="YJFGX" id="YJFGX" autocomplete="off" readonly="readonly" 
						   class="layui-input dataField form-control">
					</td>
					<td class="td-text">
						<label>联系电话：</label>
					</td>
					<td class="td-content">
						<input type="text" name="LXDH" id="LXDH" autocomplete="off" readonly="readonly" 
						   class="layui-input dataField form-control">
					</td>
					<td class="td-text">
						<label>身份证号：</label>
					</td>
					<td class="td-content">
						<input type="text" name="SFZH" id="SFZH" autocomplete="off" readonly="readonly" 
						   class="layui-input dataField form-control">
					</td>
				</tr>
			</table>
		</div>
		<div class="easyui-panel" title="居民基本情况">
			<table class="form-table">
				<tr>
					<!-- <td class="td-content" colspan="8" style="border: none;">
						<ul id="rqflUl">
						</ul>
					</td> -->
					<td class="td-text" >
						<label>居民基本情况：</label>
					</td>
					<td class="td-content" colspan="5">
						<input type="text" name="RQFLMC" id="RQFLMC" autocomplete="off" readonly="readonly" 
						   class="layui-input dataField form-control">
					</td>
				</tr>
			</table>
		</div>
		<div class="easyui-panel" title="家庭成员" data-options="tools:'#toolJtcygl'">
			<table id="jtcyTable" class="form-table">
			</table>
		</div>
		<div class="easyui-panel" title="签约信息" data-options="tools:'#toolQyxx'">
			<div id="toolQyxx">
				<span onclick="findLsjl()" href="javascript:void(0)">历史记录</span>
			</div>
			<table id="qyxxTable" class="form-table">
				<tr>
					<td class="td-text">
						<label>服务包：</label>
					</td>
					<td class="td-content" colspan="5">
						<input type="text" id="FWBMC" name="FWBMC" readonly="readonly" autocomplete="off" 
							   class="layui-input form-control isTitle">
					</td>
				</tr>
				<tr>
					<td class="td-text">
						<label>所在医院：</label>
					</td>
					<td>
						<input type="text" id="SZYY" name="SZYY" readonly="readonly" autocomplete="off" 
							   class="layui-input form-control isTitle">
					</td>
					<td class="td-text">
						<label>签约团队：</label>
					</td>
					<td>
						<input type="text" id="TDMC" name="TDMC" readonly="readonly" autocomplete="off"
							   class="layui-input form-control isTitle">
					</td>
					<td class="td-text">
						<label>记录人员：</label>
					</td>
					<td>
						<input type="text" id="JLRY" name="JLRY" readonly="readonly" autocomplete="off"
							   class="layui-input form-control">
					</td>
				</tr>
				<tr>
					<td class="td-text">
						<label>签约日期：</label>
					</td>
					<td>
						<input type="text" name="QYSJ" id="QYSJ" readonly="readonly" autocomplete="off" 
							   class="layui-input dataField form-control">
					</td>
					<td class="td-text">
						<label>生效日期：</label>
					</td>
					<td>
						<input type="text" name="SXSJ" id="SXSJ" readonly="readonly" autocomplete="off"
							   class="layui-input dataField form-control">
					</td>
					<td class="td-text">
						<label>结束日期：</label>
					</td>
					<td>
						<input type="text" name="JSSJ" id="JSSJ" readonly="readonly" autocomplete="off"
							   class="layui-input dataField form-control">
					</td>
				</tr>
			</table>
		</div>
</div>